Tag: nevin manimala

J Med Internet Res. 2023 Mar 23;25:e43542. doi: 10.2196/43542.

ABSTRACT

BACKGROUND: Digital technologies have the potential to contribute to health promotion and disease prevention in the aging world.

OBJECTIVE: This study aims to identify digital technologies for health promotion and disease prevention that could be used independently by older people in nonclinical settings using a scoping review.

METHODS: Through database (MEDLINE, PsycINFO, CINAHL, and SCOPUS; to March 3, 2022) and manual searches (to June 14, 2022), 90 primary studies and 8 systematic reviews were included in this scoping review. The eligibility was based on the PCC (Population, Concept, and Context) criteria: (1) people aged 50 years or older (population), (2) any digital (health) technology (eg, smartphone apps, websites, virtual reality; concept), and (3) health promotion and disease prevention in daily life in nonclinical and noninstitutional settings (context). Data items included study characteristics, PCC criteria, opportunities versus challenges, and evidence gaps. Data were synthesized using descriptive statistics or narratively described by identifying common themes.

RESULTS: The studies were published in 2005-2022 and originated predominantly from North America and Europe. Most primary studies were nonrandomized, reported quantitative data, and investigated effectiveness or feasibility (eg, acceptance or usability) of digital technologies in older people. The participants were aged 50 years to 99 years, predominantly female, affluent (ie, with high income, education, and digital competence), and intended to use or used digital technologies for a median of 3 months independently at home or in community settings. The digital technologies included mobile or nonmobile technologies or virtual reality. The studies used “modern devices” (eg, smartphones, wearables, or gaming consoles) or modern and “older devices” (eg, computers or mobile phones). The users interacted with digital technologies via websites, emails, text messages, apps, or virtual reality. Health targets of digital technologies were mobility, mental health, nutrition, or cognition. The opportunities versus challenges of digital technologies were (1) potential health benefits versus unclear or no benefits for some outcomes, (2) monitoring of health versus ethical issues with data collection and management, (3) implications for functioning in daily life (ie, potential to prolong independent living) versus unclear application for clinical management or care, (4) tailoring of technical properties and content toward older users versus general use, (5) importance of human support for feasibility versus other factors required to improve feasibility, (6) reduction of social isolation versus access to digital technologies, and (7) improvement in digital competence versus digital divide.

CONCLUSIONS: Various digital technologies were independently used by people aged 50 years or older for health promotion and disease prevention. Future studies should focus on (1) more diverse populations of older people, (2) new digital technologies, (3) other (clinical and care) settings, and (4) outcome evaluation to identify factors that could enhance any health benefits of digital technologies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/37729.

PMID:36951896 | DOI:10.2196/43542

Interact J Med Res. 2023 Mar 23;12:e45898. doi: 10.2196/45898.

ABSTRACT

BACKGROUND: The presence of a high left ventricular end-diastolic diameter (LVEDD) has been linked to a less favorable outcome in patients undergoing coronary artery bypass grafting (CABG) procedures. However, by taking into consideration the reference of left ventricular size and volume measurements relative to the patient’s body surface area (BSA), it has been suggested that the accuracy of the predicting outcomes may be improved.

OBJECTIVE: We propose that BSA weighted LVEDD (bLVEDD) is a more accurate predictor of outcomes in patients undergoing CABG compared to simply using LVEDD alone.

METHODS: This study was a comprehensive retrospective cohort study that was conducted across multiple medical centers. The inclusion criteria for this study were patients who were admitted for treatment between October 2016 and May 2021. Only elective surgery patients were included in the study, while those undergoing emergency surgery were not considered. All participants in the study received standard care, and their clinical data were collected through the institutional registry in accordance with the guidelines set forth by the Society of Thoracic Surgeons National Adult Cardiac Database. bLVEDD was defined as LVEDD divided by BSA. The primary outcome was in-hospital all-cause mortality (30 days), and the secondary outcomes were postoperative severe adverse events, including use of extracorporeal membrane oxygenation, multiorgan failure, use of intra-aortic balloon pump, postoperative stroke, and postoperative myocardial infarction.

RESULTS: In total, 9474 patients from 5 centers under the Chinese Cardiac Surgery Registry were eligible for analysis. We found that a high LVEDD was a negative factor for male patients’ mortality (odds ratio 1.44, P<.001) and secondary outcomes. For female patients, LVEDD was associated with secondary outcomes but did not reach statistical differences for morality. bLVEDD showed a strong association with postsurgery mortality (odds ratio 2.70, P<.001), and secondary outcomes changed in parallel with bLVEDD in male patients. However, bLVEDD did not reach statistical differences when fitting either mortality or severer outcomes in female patients. In male patients, the categorical bLVEDD showed high power to predict mortality (area under the curve [AUC] 0.71, P<.001) while BSA (AUC 0.62) and LVEDD (AUC 0.64) both contributed to the risk of mortality but were not as significant as bLVEDD (P<.001).

CONCLUSIONS: bLVEDD is an important predictor for male mortality in CABG, removing the bias of BSA and showing a strong capability to accurately predict mortality outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02400125; https://clinicaltrials.gov/ct2/show/NCT02400125.

PMID:36951893 | DOI:10.2196/45898

JAMA Netw Open. 2023 Mar 1;6(3):e234211. doi: 10.1001/jamanetworkopen.2023.4211.

ABSTRACT

IMPORTANCE: There is uncertainty as to which estimated glomerular filtration rate (eGFR) equation should be used among older adults.

OBJECTIVE: To compare the 5 most commonly used creatinine-based eGFR equations in older adults, quantifying the concordance among the equations, comparing their discriminative capacity in regards to 15-year mortality, and identifying sources of potential discrepancies.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), a longitudinal study of adults aged 60 years or older in Sweden. Participants were recruited between 2001 and 2004 and followed up for mortality until December 2016. Participants missing creatinine values were excluded. Data were originally analyzed March through July 2022, and were rerun in January 2023.

EXPOSURES: Five creatinine-based equations were considered: Modification of Diet in Renal Disease (MDRD), 2009 Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI), Revised Lund-Malmö (RLM), Berlin Initiative Study (BIS), and European Kidney Function Consortium (EKFC).

MAIN OUTCOMES AND MEASURES: Concordance between equations was quantified using Cohen κ. Discriminative capacity for mortality was quantified using area under the receiver operating characteristic curve (AUC) and the Harrel C statistic. Calf circumference, body mass index (BMI), and age were explored as correlates of discrepancies.

RESULTS: The study sample consisted of 3094 older adults (1972 [63.7%] female; median [IQR] age, 72 [66-81] years). Cohen κ between dyads of equations ranged from 0.42 to 0.91, with poorest concordance between MDRD and BIS, and best between RLM and EKFC. MDRD and CKD-EPI provided higher estimates of GFR compared with the other equations. The best mix of AUC and Harrel C statistic was observed for BIS (0.80 and 0.73, respectively); however, the prognostic accuracy for death decreased among those aged over 78 years and those with low calf circumference. Differences between equations were inconsistent across levels of calf circumference, BMI, and age.

CONCLUSIONS AND RELEVANCE: In this cohort study, we found that eGFR equations were not interchangeable when assessing kidney function. BIS outperformed other equations in predicting mortality; however, its discriminative capacity was reduced in subgroup analyses. Clinicians should consider these discrepancies when monitoring kidney function in old age.

PMID:36951865 | DOI:10.1001/jamanetworkopen.2023.4211

JAMA Netw Open. 2023 Mar 1;6(3):e234415. doi: 10.1001/jamanetworkopen.2023.4415.

ABSTRACT

IMPORTANCE: Prior studies using large registries have suggested a modest increase in risk for neurodevelopmental diagnoses among children of mothers with immune activation during pregnancy, and such risk may be sex-specific.

OBJECTIVE: To determine whether in utero exposure to SARS-CoV-2 is associated with sex-specific risk for neurodevelopmental disorders up to 18 months after birth, compared with unexposed offspring born during or prior to the COVID-19 pandemic period.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included the live offspring of all mothers who delivered between January 1 and December 31, 2018 (born and followed up before the COVID-19 pandemic), between March 1 and December 31, 2019 (born before and followed up during the COVID-19 pandemic), and between March 1, 2020, and May 31, 2021 (born and followed up during the COVID-19 pandemic). Offspring were born at any of 8 hospitals across 2 health systems in Massachusetts.

EXPOSURES: Polymerase chain reaction evidence of maternal SARS-CoV-2 infection during pregnancy.

MAIN OUTCOMES AND MEASURES: Electronic health record documentation of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes corresponding to neurodevelopmental disorders.

RESULTS: The COVID-19 pandemic cohort included 18 355 live births (9399 boys [51.2%]), including 883 (4.8%) with maternal SARS-CoV-2 positivity during pregnancy. The cohort included 1809 Asian individuals (9.9%), 1635 Black individuals (8.9%), 12 718 White individuals (69.3%), and 1714 individuals (9.3%) who were of other race (American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, more than 1 race); 2617 individuals (14.3%) were of Hispanic ethnicity. Mean maternal age was 33.0 (IQR, 30.0-36.0) years. In adjusted regression models accounting for race, ethnicity, insurance status, hospital type (academic center vs community), maternal age, and preterm status, maternal SARS-CoV-2 positivity was associated with a statistically significant elevation in risk for neurodevelopmental diagnoses at 12 months among male offspring (adjusted OR, 1.94 [95% CI 1.12-3.17]; P = .01) but not female offspring (adjusted OR, 0.89 [95% CI, 0.39-1.76]; P = .77). Similar effects were identified using matched analyses in lieu of regression. At 18 months, more modest effects were observed in male offspring (adjusted OR, 1.42 [95% CI, 0.92-2.11]; P = .10).

CONCLUSIONS AND RELEVANCE: In this cohort study of offspring with SARS-CoV-2 exposure in utero, such exposure was associated with greater magnitude of risk for neurodevelopmental diagnoses among male offspring at 12 months following birth. As with prior studies of maternal infection, substantially larger cohorts and longer follow-up will be required to reliably estimate or refute risk.

PMID:36951861 | DOI:10.1001/jamanetworkopen.2023.4415

JAMA Otolaryngol Head Neck Surg. 2023 Mar 23. doi: 10.1001/jamaoto.2023.0159. Online ahead of print.

ABSTRACT

IMPORTANCE: Effect size quantifies the magnitude of the difference or the strength of the association between variables. In clinical research it is important to calculate and report the effect size and the confidence interval (CI) because it is needed for sample size calculation, meaningful interpretation of results, and meta-analyses.

OBSERVATIONS: There are many different effect size measures that can be organized into 2 families or groups-d family and r family. The d family includes measures that quantify the differences between groups. The r family includes measures that quantify the strength of the association. Effect sizes that are presented in the same units as the characteristic being measured and compared are known as nonstandardized or simple effect sizes. The nonstandardized effect sizes have the advantage of being more informative, easier to interpret, and easier to evaluate in the light of clinical significance or practical relevance. Standardized effect sizes are unit-less and are helpful for combining and comparing effects of different outcome measures or across different studies (ie, meta-analysis).

CONCLUSIONS AND RELEVANCE: The choice of the correct effect size measure depends on the research question, study design, targeted audience, and the statistical assumptions being made. For a complete and meaningful interpretation of results from a clinical research study, the investigator should make clear the type of effect size being reported, its magnitude and direction, degree of uncertainty of the effect size estimate as presented by the CIs, and whether the results are compatible with a clinically meaningful effect.

PMID:36951858 | DOI:10.1001/jamaoto.2023.0159

J Vis. 2023 Mar 1;23(3):12. doi: 10.1167/jov.23.3.12.

ABSTRACT

A critical function of the human visual system is to track emotion accurately and continuously. However, visual information about emotion fluctuates over time. Ideally, the visual system should track these temporal fluctuations-these “natural emotion statistics” of the world-over time. This would balance the need to detect changes in emotion with the need to maintain the stability of visual scene representations. The visual system could promote this goal through serial dependence, which biases our perception of facial expressions toward those seen in the recent past and thus smooths our perception of the world. Here, we quantified the natural emotion statistics in videos by measuring the autocorrelations in emotional content present in films and movies. The results showed that observers’ perception of emotion was smoothed over ∼12 seconds or more, and this time-course closely followed the temporal fluctuations in visual information about emotion found in natural scenes. Moreover, the temporal and feature tuning of the perceptual smoothing was consistent with known properties of serial dependence. Our findings suggest that serial dependence is introduced in the perception of emotion to match the natural autocorrelations that are observed in the real world, an operation that could improve the efficiency, sensitivity, and stability of emotion perception.

PMID:36951852 | DOI:10.1167/jov.23.3.12

AANA J. 2023 Apr;91(2):119-124.

ABSTRACT

Advanced practice nurses are not currently recognized in Georgia, the country intersecting Eastern Europe and Western Asia. With a critical nursing shortage and the brain-drain of graduate nurses in Georgia seeking higher pay and more respect in other countries, it is an opportune time to examine the potential for advancing nursing practice through education and professional mentorship. The aim of the study was two-fold. The first goal was to educate the local community about the profession of advanced practice nurse anesthesia and the benefits of advanced practice nursing in Georgia through a certified registered nurse anesthetist-led education session designed for a cohort of undergraduate biochemistry students. Second, a qualitative analysis identified the current state of nursing practice and directed the next steps toward nursing advancement, regulation, professionalism, access to quality care, and globally acceptable standards of practice. An education session held at San Diego State University Tbilisi, although not statistically significant, was successful in improving public knowledge. Qualitatively, the study established extreme enthusiasm for developing a nurse anesthesia program, licensure, regulation, standards of care, continuing education, and quality. In a country eager to advance, certified registered nurse anesthetists have the distinct opportunity of supporting Georgia’s movement toward westernized healthcare.

PMID:36951840

AANA J. 2023 Apr;91(2):93-105.

ABSTRACT

The purpose of this study was to evaluate the safety and efficacy of buprenorphine compared with placebo in prolonging the duration of analgesia in single-injection peripheral nerve block. The systematic review and meta-analysis were conducted following the PRISMA statement and Review Manager was used for meta-analysis. Outcomes were calculated using the mean difference (MD) with 95% confidence interval (CI) for continuous data. For dichotomous outcomes, effect sizes were estimated by calculating pooled risk ratio (RR) with 95% CI. Statistical heterogeneity was estimated by the I² statistic. Compared with placebo, buprenorphine prolonged the duration of analgesia by an average of 8 hours (MD, 8.01; 95% CI, 6.79 to 9.24; P < .00001). The cumulative pain scores within 24 hours (MD, -0.8; 95% CI, -1.21 to -0.40; P < .0001) and the 24-hour opioid consumption (MD, -5.56; 95% CI, -10.60 to -0.52; P = .03) after surgery was lower with buprenorphine group. Conversely, buprenorphine increased the incidence of postoperative nausea and vomiting (PONV) (RR, 1.67; 95% CI, 1.16 to 2.39; P = .006). Buprenorphine is effective in prolonging analgesia, decreasing pain scores and opioid consumption, however, it increases the risk of PONV.

PMID:36951837

JAMA Ophthalmol. 2023 Mar 23. doi: 10.1001/jamaophthalmol.2023.0302. Online ahead of print.

ABSTRACT

IMPORTANCE: The treatment of moderate to severe meibomian gland dysfunction (MGD) with oral doxycycline requires a 6-week course of treatment and has frequent adverse effects (AEs), which may be associated with poor compliance.

OBJECTIVE: To determine if the AEs of a 3-week course of oral azithromycin were equivalent to the AEs of a 6-week course of oral doxycycline.

DESIGN, SETTING, AND PARTICIPANTS: This double-masked randomized clinical trial was conducted at a referral center in Thailand from September 2018 to May 2022. Participants with moderate to severe MGD judged unresponsive to conservative management were included.

INTERVENTIONS: Patients were randomized 1:1 to receive oral azithromycin (1 g once per week for 3 weeks) or oral doxycycline (200 mg daily for 6 weeks).

MAIN OUTCOMES AND MEASURES: After initiating therapy, the study team assessed the total MGD score and Ocular Surface Disease Index (OSDI) score at the initial visit, at 6 weeks, and at 8 weeks, and assessed AEs at 6 weeks and 8 weeks. The prespecified equivalence margins for MGD score and OSDI score were set at ±2 and ±9, respectively.

RESULTS: A total of 137 eyes from 137 patients were randomized into groups, 68 eyes in the azithromycin group and 69 eyes in the doxycycline group (female, 66.4%; mean age, 62.0 [SD, 15.1] years). The adjusted mean difference of total MGD scores between groups at week 6 and week 8 were -0.33 (95% CI, -1.70 to 1.03; P for equivalence = .01) and 0.13 (95% CI, -1.59 to 1.84; P for equivalence = .02), respectively. The adjusted mean difference of OSDI between groups score at week 6 and week 8 was -1.20 (95% CI, -5.31 to 2.91; P for equivalence < .001) and -1.59 (95% CI, -5.73 to 2.55; P for equivalence < .001), respectively. In addition, patients treated with azithromycin had fewer gastrointestinal AEs (4.4% vs 15.9%; risk difference, 11.5%; 95% CI 1.6%-21.4%; P = .03).

CONCLUSIONS AND RELEVANCE: These data support an equivalency of effects of azithromycin as compared with doxycycline for MGD score and OSDI score at both follow-up times. The study did not show more gastrointestinal AEs in the azithromycin group. The reduced dosing and potentially fewer gastrointestinal AEs associated with azithromycin support its use as an alternative to doxycycline for at least 6 weeks.

TRIAL REGISTRATION: ThaiClinicalTrials.org Identifier: TCTR20180810001.

PMID:36951835 | DOI:10.1001/jamaophthalmol.2023.0302

J Urol. 2023 Mar 9:101097JU0000000000003396. doi: 10.1097/JU.0000000000003396. Online ahead of print.

ABSTRACT

PURPOSE: Despite family history being an established risk factor for prostate cancer, the role of a broader definition of family history inclusive of not just prostate cancer but other genetically related malignancies has not been investigated in the active surveillance population. Here, we evaluate the impact of an expanded definition of family history on active surveillance outcomes.

MATERIALS AND METHODS: Patients undergoing active surveillance for prostate cancer at Massachusetts General Hospital from 1997-2019 with detailed data available on family cancer history were identified. Primary outcome was biopsy progression-free survival, and secondary outcomes were treatment-free survival, adverse pathological features at prostatectomy, and biochemical recurrence after treatment. Statistical analyses were conducted using the Kaplan-Meier method and Cox regression.

RESULTS: Among 855 evaluable patients, 300 (35.1%) patients had any family history of prostate cancer, and 95 (11.1%) had a family history of related malignancies suggestive of a hereditary cancer syndrome (family history of hereditary cancer syndrome). Family history of prostate cancer alone was not associated with biopsy progression, whereas family history of hereditary cancer syndrome was associated with a significantly increased risk of biopsy progression (HR 1.43, 95%CI 1.01-2.02), independent of other known clinicopathological risk factors in multivariable analysis. Similarly, family history of hereditary cancer syndrome was associated with significantly lower treatment-free survival (HR 1.58, 95%CI 1.14-2.18) in multivariable analysis. No significant association was found between family history and adverse features on surgical pathology or biochemical recurrence.

CONCLUSIONS: An expanded family history suggestive of a hereditary cancer syndrome is an independent predictor of biopsy progression during active surveillance. Men with such a family history may still be offered active surveillance but should be counseled regarding the higher risk of disease progression.

PMID:36951811 | DOI:10.1097/JU.0000000000003396